Staging liver cancer can be especially challenging because your doctor must also consider any underlying conditions you may have. This makes it important that you learn everything you can about your type of liver cancer and its stage. This information will help you to partner with your doctor as you make decisions regarding your treatment and quality of life.
Staging is a process used to describe the extent of the cancer in your body and how far it might have progressed from where it began. This will require results from physical exams, blood tests, imaging studies and biopsies. Blood tests will look for a biomarker called alpha-fetoprotein (AFP), determine whether you have hepatitis B or C, and see how well your liver is functioning. Imaging studies may include an ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and an angiogram.
Unlike with other cancers, a biopsy is not always required to establish a diagnosis of HCC. If you have an underlying liver disease such as cirrhosis and if your tumor meets all of the specific radiographic criteria to establish a diagnosis of HCC, then a biopsy is not required. There are some risks associated with liver biopsy, so a biopsy is performed only in situations in which it is deemed necessary and helpful.
Understanding the Pathology Report
The results of the physical exams, blood tests, imaging studies and biopsies are compiled with the pathology report (if one exists) and used to assign a stage to your cancer. Staging by surgical pathology is based on careful examination of the entire tumor if resection (removal of the tumor with or without lymph nodes) is performed.
Your pathology report provides information about the unique characteristics of your cancer. It is prepared by a pathologist, who is a physician with specialized training in determining the nature of disease. The pathologist examines the tissue specimen with and without a microscope, documenting its size, describing its appearance and, sometimes, performing special testing.
Patients often do not see their pathology reports, but you can request that your doctor share yours with you.
If you decide to get a second opinion from another specialist, request that a copy of your pathology report be sent. That can be beneficial, especially if there was difficulty or controversy in interpreting the findings. Other specialists can confirm the diagnosis and stage of cancer and answer any additional questions you may have. Most doctors welcome a second opinion and will recommend another physician or hospital. Above all, the goal is for you to have the best care available.
How HCC is Staged
Because of the complexity of diagnosing liver cancer and its underlying conditions, several different staging systems have been developed. The two commonly used for HCC are the Barcelona Clinic Liver Cancer (BCLC) system and the American Joint Committee on Cancer (AJCC) staging system. To stage cancer, both use characteristics for evaluating the extent of your liver cancer, and the BCLC system also incorporates the health of your liver.
The two staging systems are explained in more detail below. Ask your doctor which system is being used and what that means for your treatment plan.